Purpose
To develop, conduct, and evaluate a proactive risk assessment (PRA) of the design and implementation of CPOE in an ICU.
Methods
We developed a PRA method based on issues identified from documented experience with conventional PRA methods and the constraints of an organization about to implement CPOE in an intensive care unit. The PRA method consists of three phases: planning (three months), team (one five-hour meeting), and evaluation (short- and long-term).
Results
Sixteen unique relevant vulnerabilities were identified as a result of the PRA team’s efforts. Negative consequences resulting from the vulnerabilities included potential patient safety and quality of care issues, non-compliance with regulatory requirements, increases in cognitive burden on CPOE users, and/or worker inconvenience or distress. Actions taken to address the vulnerabilities included redesign of the technology, process (workflow) redesign, user training, and/or ongoing monitoring. Verbal and written evaluation by the team members indicated that the PRA method was useful and that participants were willing to participate in future PRAs. Long-term evaluation was accomplished by monitoring an ongoing “issues list” of CPOE problems identified by or reported to IT staff. Vulnerabilities identified by the team were either resolved prior to CPOE implementation (n = 7) or shortly thereafter (n = 9). No other issues were identified beside those identified by the team.
Conclusions
Generally positive results from the various evaluations including a long-term evaluation demonstrate the value of developing an efficient PRA method that meets organizational and contextual requirements and constraints.
Integrating the EHR, that is, enabling the EHR and other software applications to exchange data with each other without loss of meaning or accuracy, is one of the critical tasks of the EHR implementation and of ongoing production support. Integrating the EHR begins with defining the components to be integrated. The EHR suite is a suite of applications that you purchase from the vendor and that share a common database. It may include scheduling, registration, outpatient EHR, inpatient EHR, Emergency Department EHR, ADT, pharmacy, laboratory billing, and other applications. Ancillary applications are external to the EHR suite, but send information to the suite's database (for example, laboratory and pathology results) and may receive information from it (e.g., patient demographics) (see Figure 11.1).While part of the value proposition of buying an EHR suite from one vendor is that the suite's components are theoretically integrated from the design stage forward, this is not likely to be entirely the case. So EHR integration has a dual focus: first on establishing interfaces with ancillary applications, and second on integrating data definitions and shared software functions within the EHR suite.
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